Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan Consumer Advisory Committee Meeting AGENDA

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1 Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan Consumer Advisory Committee Meeting 711 E. Daily Drive, Suite 106, Camarillo, CA Wednesday, March 18, :00 p.m. AGENDA CALL TO ORDER / ROLL CALL WELCOME AND INTRODUCTIONS PUBLIC COMMENT A Speaker Card must be completed and submitted to the Secretary of the Committee by anyone wishing to comment: Public Comment Comments regarding items not on the agenda but within the subject matter jurisdiction of the Committee. Agenda Item Comment Comments on the subject matter jurisdiction of the Committee pertaining to a specific item on the agenda. The speaker is recognized and introduced by the Committee Chair during the Committee s consideration of the item. APPROVE MINUTES 1. Regular Meeting of December 10, 2014 DISCUSSION ITEMS 2. CEO / COO Update Ruth Watson, Interim CEO / COO 3. CFO Update John Meazzo, Interim Chief Financial Officer 4. Action Item Update Luis Aguilar, Member Services Manager 5. Rainbow Connection Update Laurie Jordan, Rainbow Connection FRC 6. Operations Update Tami Lewis, Director of Operations Meeting Agenda available at ADMINISTRATIVE REPORTS RELATING TO THIS AGENDA AND MATERIALS RELATED TO AN AGENDA ITEM SUBMITTED TO THE COMMITTEE AFTER DISTRIBUTION OF THE AGENDA PACKET ARE AVAILABLE FOR PUBLIC REVIEW DURING NORMAL BUSINESS HOURS AT THE OFFICE OF THE SECRETARY OF THE COMMITTEE, 711 E. DAILY DRIVE, SUITE 106, CAMARILLO, CA IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, IF YOU NEED SPECIAL ASSISTANCE TO PARTICIPATE IN THIS MEETING, PLEASE CONTACT CONNIE AT (805) REASONABLE ADVANCE NOTIFICATION OF THE NEED FOR ACCOMMODATION PRIOR TO THE MEETING (48 HOURS ADVANCE NOTICE IS PREFERABLE) WILL ENABLE US TO MAKE REASONABLE ARRANGEMENTS TO ENSURE ACCESSIBILITY TO THIS MEETING.

2 Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan March 18, 2015 Consumer Advisory Committee Meeting Agenda (continued) PLACE: 711 E. Daily Drive, Suite 106, Camarillo, CA TIME: 5:00 p.m. 7. Government Relations Update Guillermo Gonzalez, Director of Government Affairs 8. Behavioral Health Utilization Demographics Dr. Nancy Wharfield, Associate Chief Medical Officer 9. Newsletter and Annual Report Update Steven Lalich, Director of Communications 10. Pharmacy Benefits Overview Anne Freese, Pharmacy Director 11. Health Education Update Lupe Gonzalez, PhD, MPH, Director of Health Education COMMENTS FROM COMMITTEE MEMBERS ADJOURNMENT Unless otherwise determined by the Committee, the next regular meeting of the Consumer Advisory Committee will be held on June 17, 2015 at 5:00 p.m. at 711 E. Daily Drive, Suite 106, Camarillo, CA Meeting Agenda available at ADMINISTRATIVE REPORTS RELATING TO THIS AGENDA AND MATERIALS RELATED TO AN AGENDA ITEM SUBMITTED TO THE COMMITTEE AFTER DISTRIBUTION OF THE AGENDA PACKET ARE AVAILABLE FOR PUBLIC REVIEW DURING NORMAL BUSINESS HOURS AT THE OFFICE OF THE SECRETARY OF THE COMMITTEE, 711 E. DAILY DRIVE, SUITE 106, CAMARILLO, CA IN COMPLIANCE WITH THE AMERICANS WITH DISABILITIES ACT, IF YOU NEED SPECIAL ASSISTANCE TO PARTICIPATE IN THIS MEETING, PLEASE CONTACT CONNIE AT (805) REASONABLE ADVANCE NOTIFICATION OF THE NEED FOR ACCOMMODATION PRIOR TO THE MEETING (48 HOURS ADVANCE NOTICE IS PREFERABLE) WILL ENABLE US TO MAKE REASONABLE ARRANGEMENTS TO ENSURE ACCESSIBILITY TO THIS MEETING.

3 Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan (GCHP) Consumer Advisory Committee Minutes December 10, 2014 (Not official until approved) CALL TO ORDER Director of Operations Tami Lewis called the meeting to order at 5:05 p.m. in Suite 200 of the Ventura County Public Health Building located at 2240 E. Gonzales Road, Oxnard, CA ROLL CALL COMMITTEE MEMBERS IN ATTENDANCE Rita Duarte-Weaver, Ventura County Public Health Department Alicia Flores, La Hermandad Michelle Gerardi, Beneficiary (Arrived at 5:25 p.m.) Norma Gomez, Mixteco / Indigena Community Organizing Project Frisa Herrera, Casa Pacifica Paula Johnson, ARC of Ventura County Laurie Jordan, Rainbow Connection / Tri-Counties Regional Center Ruben Juarez, County Health Care Agency Curtis Updike, County Human Services Agency (HSA) EXCUSED / ABSENT COMMITTEE MEMBERS Pedro Mendoza, Tri-Counties Regional Center Katharine Raley, County of Ventura Area Agency on Aging STAFF IN ATTENDANCE Tami Lewis, Director of Operations Ruth Watson, Chief Operating Officer / Interim Chief Executive Officer John Meazzo, Interim Chief Financial Officer Connie Harden, Member Services Specialist Luis Aguilar, Member Services Manager Vickie Connaughton, Health Education Specialist Stacy Cortez, Member Services Representative William Freeman, Director of Network Operations Guillermo Gonzalez, Director of Government Affairs Steve Lalich, Director of Communications Al Reeves, MD, Chief Medical Officer Terry Wagemann, Facility Site Review Nurse / Quality Improvement Nancy Wharfield, MD, Associate Chief Medical Officer Language interpreting and translating services were provided by GCHP from Lourdes González Campbell and Associates. GCHP Consumer Advisory Committee Meeting Minutes December 10, Page 1 of 5 1-1

4 The Pledge of Allegiance was recited. WELCOME AND INTRODUCTIONS Director of Operations Tami Lewis welcomed the Committee. PUBLIC COMMENT / CORRESPONDENCE None APPROVAL MINUTES 1. Regular Meeting of September 17, 2014 Committee Member Curtis Updike moved to approve the Meeting Minutes of September 17, Committee Member Paula Johnson seconded. The motion carried with the following vote: AYE: Duarte-Weaver, Flores, Gomez, Herrera, Johnson, Jordan, Juarez, and Updike. NAY: None. ABSTAIN: None. ABSENT: Mendoza, Raley and Gerardi. RECUSED: None. APPROVAL ITEMS None DISCUSSION ITEMS 2. CEO / COO Update Chief Operating Officer (COO) / Interim Chief Executive Officer (CEO) Ruth Watson presented an overview of the Department of Health Care Services (DHCS) All-Plan CEO Meeting held Friday, December 5, 2014 in Sacramento. SWEARING IN OF COMMITTEE MEMBERS Member Services Specialist Connie Harden swore-in Committee Member Rita Duarte- Weaver and Committee Member Michelle Gerardi. 3. CFO Update Interim Chief Financial Officer (CFO) John Meazzo reviewed the update as presented to the Committee. RECESS A break was provided at 5:55 p.m. The meeting reconvened at 6:15 p.m. GCHP Consumer Advisory Committee Meeting Minutes December 10, Page 2 of 5 1-2

5 4. Operations Update Director of Operations Tami Lewis reported on the Operations Update as presented. Director Lewis stated that we have exceeded enrollment expectations and currently are at membership numbers not expected until June of Director Lewis went on to state that all metrics are being met, calls are being answered and not abandoned, claims are being paid and operations are running smoothly. COO / Interim CEO Watson stated that this is not the case in other counties and that GCHP has partnered well with the County in order to provide these services. COO / Interim CEO Watson went on to say that since January of 2014, we have added 53,000 new members to Medi-Cal in Ventura County; 53,000 people who did not have coverage before. Committee Member Laurie Jordan asked if we had sufficient Providers for these additional members. COO / Interim CEO Watson stated that we do have sufficient Providers in the county and meet the State s standards, but that we are always looking to add Providers to our panel. Discussion was held about the challenges of some specialty groups in our County. Committee Member Michelle Gerardi asked questions about standards for specialty appointment wait times. Associate Chief Medical Officer Nancy Wharfield responded that if there are problems with timely appointments, we encourage members to file grievances if these standards are not met. Committee Member Jordan asked about statistics on members utilizing Beacon Health Strategy services. COO / Interim CEO Watson stated that we can provide a demographics report on member usage of Beacon Health Strategies services. 5. Government Affairs Update Director of Government Affairs Guillermo Gonzalez reviewed his report on the November midterm elections and its potential impact on Medicaid / Medi-Cal. Committee Member Gerardi asked if the new Denti-Cal benefit for adults may be cut if there are budget cuts. Director Gonzalez stated that Denti-Cal for adults was funded last year and for the foreseeable future and we don t know what may happen going forward. Director Gonzalez will report back to the Committee as the budget develops. Committee Member Alicia Flores asked about assistance for undocumented persons. Director Gonzalez stated that there is a program being looked at for the undocumented and that we are following this and will report on it at future meetings. 6. Associate CMO Update Associate Chief Medical Officer (Associate CMO) Dr. Nancy Wharfield presented information on a diabetes disease management program which will begin next year. Associate CMO Wharfield discussed the program and its goals. She went on to say that GCHP is targeting those members with mild to moderate diabetes in an attempt to hold them at that level of severity. Associate CMO Wharfield stated that GCHP will be performing outreach to those members by mailings and phone calls along with incentives for members who attend health education classes and participate in other programs. Committee Member Frisa Herrera asked what the turnaround time is for members to receive their movie tickets from the retinal screening incentive. Chief Medical Officer (CMO) Dr. Al Reeves stated that the tickets would likely be sent within a month or two, once the verifications have been made. COO / Interim CEO Watson stated that the incentive program was very popular and that vision provider, VSP, asked what we had done because the response was better than anyone else s. GCHP Consumer Advisory Committee Meeting Minutes December 10, Page 3 of 5 1-3

6 Associate CMO Wharfield presented the new method of providing Non-Emergency Medical Transportation (NEMT) for members. Associate CMO Wharfield stated that this benefit is very limited and the specifics for qualifying for this benefit are stringent. A prescription from the doctor and an authorization from GCHP will now be required. 7. Communications Update Director of Communications Steve Lalich presented information on the member newsletter and other GCHP publications. Director Lalich commented on the timeliness of the new Medi-Cal redetermination process and the article scheduled for the next newsletter that will be in members homes in March He went on to state that it shows how we are working together with the County on getting word out to members on the new process. Director Lalich added the next newsletter will contain a lot of localized information including information on the new autism benefit and the use of emergency room services versus urgent care facilities. Director Lalich also spoke of the three E-newsletters available on the GCHP website. These are opt-in newsletters - one on pregnancy, one for new parents and one on keeping well. The process was explained along with details on the newsletters. 8. Health Education Update Chief Medical Officer (CMO) Dr. Al Reeves presented the Health Education update. He commented on the incentive programs that have been successfully used by other health plans and the results the incentives have had on these plans Health Effectiveness Data and Information Set (HEDIS) scores. CMO Reeves stated that GCHP is now mature enough to go into our first incentive program and that we chose to look at those members with diabetes who had not had their retinal eye exam this year. CMO Reeves added that there were about 3,700 members targeted and approximately 360 had had their exam. Members were sent a letter encouraging them to get their retinal eye exam for this year and once they had the exam and it was verified by their doctor, we would send them two movie tickets. He went on to explain that retinopathy is the third highest cause of blindness in the U.S. and it is treatable and preventable if treated. CMO Reeves said that the current program ends at the end of this year but we anticipate rolling the program over to next year. 9. Covered CA Update Committee Member Rita Duarte-Weaver stated that open enrollment for Covered CA is ongoing. Members who need to re-enroll for their services or apply new for Covered CA services must have their applications in by December 15, 2014 so that their services will begin January 1, Committee Member Duarte-Weaver reviewed the new Covered CA enrollment guide as presented in the Committee members packet. She stated it is the most effective product put out as it walks the applicants through the process, step by step, with full information. Committee Member Duarte-Weaver went on to comment on outreach events they are attending and the positive response to the new materials and their ease of use. Committee Member Duarte-Weaver stated that their office created a list of Certified Insurance Agents in Ventura County for Covered CA and will provide the list to the Committee. She stated that people renewing their coverage are being referred back to the person who assisted them last year, and if the person is a new applicant, referring them to the agents or advising them to call Covered CA. She stated the list of Certified Insurance Agents is on the Covered CA website. Committee Member Updike added that HSA vetted the agents to see if they wanted to participate and put them on the list. GCHP Consumer Advisory Committee Meeting Minutes December 10, Page 4 of 5 1-4

7 Comments from Committee Members Committee Member Updike reported that HSA received a grant for Medi-Cal outreach. He stated that Jennifer Harkey is the person handling this program and available to speak to groups. They are working on trying to get five distinct groups into Medi-Cal. ADJOURNMENT Meeting was adjourned at 7:05 p.m. GCHP Consumer Advisory Committee Meeting Minutes December 10, Page 5 of 5 1-5

8 AGENDA ITEM 3 To: From: Gold Coast Health Plan Consumer Advisory Committee John Meazzo, Interim CFO Date: March 11, 2015 Re: CFO Update Financial Update The Plan continues to generate positive net income from operations. For the six months ended December 31, 2014, total revenues were $300.8 million, and total expenses were $265 million resulting in a net income of approximately $35.8 million, a $9.8 million favorable variance to the $26 million budget. The positive variance was primarily due to the continued growth in membership with higher capitation rates (Adult Expansion). The Plan gained approximately 11,000 members since the quarter ended September 2014, and 18,643 members greater than what was estimated in the budget at December These operating results have contributed to a Tangible Net Equity (TNE) reserve level of approximately $75.6 million, which exceeded both the budget of $40.5 million and the State minimum required TNE amount of $23.8 million. Note the TNE includes the $7.2 million in lines of credit with the County of Ventura. The Plan is at approximately 318% of the minimum TNE requirement and at 287% when the lines of credit are excluded from the calculation. An investment policy has been approved by the Commission and it will be used to maximize our return on investments. 3-1

9 Ventura County Medi-Cal Managed Care Commission (VCMMCC) dba Gold Coast Health Plan Action Items Consumer Advisory Committee Meetings Date Owner Department Action Required Response 3/19/2014 Connie Harden 3/19/2014 Steve Lalich 3/19/2014 Luis Aguilar Member Services Design new Orientation meeting flyer and send out to CAC members. Communications Send information to CAC members regarding ACAP Scholarship. Member Services Contact Member Norma Gomez for information on members needing to file grievances against Clinicas El Rio. Date Completed Completed 4/14/2014 Completed 3/20/2014 Closed - Sent G&A electronic forms to Norma on 3/25/2014. Luis offered her assistance with grievance filing process. Norma was going to discuss with her supervisor the best approach to document the grievances and call Luis once determined. Called Norma on 12/12/14, to find out if they have submitted the grievances mentioned and if they needed any assistance. Will close as no response received and will reopen if needed. 12/15/2014 9/17/2014 Luis Aguilar 9/17/2014 Luis Aguilar 9/17/2014 Luis Aguilar Member Services Ruben Juarez requested reimbursement information for members who have paid outof-pocket for ABA services. Luis to provide when available. Member Services Send Personal Rep forms to Norma Gomez for MICOP reps to speak with call center agents. Member Services Send Personal Rep forms to Frisa Herrera at Casa Pacifica. Completed - Sent an to all CAC member with ABA information including the contact for reimbursement on 10/28/2014. Completed - Forms sent to Norma Gomez with a request to her to call for assistance with the forms. 10/28/2014 9/22/2014 Completed - Form sent to Frisa Herrera. 9/22/

10 Action Items 2014 Date Owner Department Action Required Response 9/17/2014 Luis Aguilar 9/17/2014 Luis Aguilar 12/10/2014 Connie Harden 12/10/2014 Connie Harden Member Services Call Center agents not able to get a Mixteco interpreter on the line for assistance. Member Services Determine an easier/faster way for members to deliver Personal Rep forms to GCHP. Member Services Include Action Item Report on each meeting agenda for follow-up purposes. Member Services Forward Action Item list from 9/17/2014 meeting to CAC members. Sent to Xerox on 9/22/14, asking about number of Mixteco interpreters available. Call Center confirmed they have limited Mixteco interpreters available. Xerox asked for members information to research the issue on the specific date of occurrance. Reached out to Norma Gomez requesting information, not yet received. Left a voice message to Norma on 12/12/14 asking for member information in order to research the issue further. Will close as no response received and will re-open if needed. Legal advised GCHP shouldn't accept a form with a signature via a cell phone due to potential PHI issues. Ongoing - Action Item report to be presented at each CAC meeting for discussion. Completed- Action Item list to be forwarded to all CAC members with status updates as needed. 12/10/2014 Dr. Wharfield 12/10/2014 Guillermo Gonzalez 12/10/2014 Connie Harden 12/10/2014 Connie Harden 12/10/2014 Lupe Gonzalez Health Services Member Services Government Affairs Provide report to CAC members of demographics of members utilizing Beacon Health Strategies Services. Report back to CAC on budget proceedings. Report on member benefits added or deleted from contract. Member Services Provide CAC members with written CEO report from 12/10/2014 meeting. Member Services Provide listing of Covered CA Certified Insurance Agents in Ventura County. Health Education Frisa Herrera/Casa Pacifica requested information on delivery of movie tickets for members who got their diabetes eye exam. One of her clients sent in his request. Dr. Wharfield determining if the information can be pulled from DSS. Will present information at 3/18/2015 CAC meeting. Ongoing - Guillermo Gonzalez to present State budget updates to the CAC as needed. Completed - Received written CEO report and forwarded to all CAC members and GCHP staff in attendance. Completed - List provided by Rita Duarte- Weaver and forwarded to all CAC members and GCHP staff. Completed - Information received from Health Education. Member information verified. Movie tickets mailed to member 12/23/2014. Date Completed 12/15/ /22/ /12/ /18/2014 To be presented at 3/18/15 CAC meeting To be presented at 3/18/15 CAC meeting 12/17/ /12/ /23/

11 AGENDA ITEM 6 To: From: Gold Coast Health Plan Consumer Advisory Committee Tami Lewis, Director of Operations Date: March 18, 2015 Re: Operations Update Membership Summary Gold Coast Health Plan (GCHP) has continued to see membership increases since we last reported enrollment information to this Committee. GCHP added 4,658 members in January, 821 members in February and 3,811 members in March to bring the total number of members enrolled in the Plan to 182,795 as of March 1, This represents an increase of 64,283 members or 54% since January 1, The cumulative new membership since January 1st is summarized as follows: L1 (Low Income Health Plan) 4,965 M1 (Adult Expansion) 34,350 7U (CalFresh Adults) 3,236 7W (CalFresh Children) 856 7S (Parents of 7Ws) 396 Traditional Medi-Cal 20,480 Member Handbook GCHP is currently undergoing the annual review of the Member Handbook and making required changes since it was last updated. The target date for the new handbook to be in production is July Member Orientation Meetings GCHP continues to hold Member Orientation meetings several times per month in various locations throughout the County. Interest in these meetings continues to be strong with 73 individuals (61 members, 12 others) attending a meeting in January or February. Of the 61 members, 51 indicated they learned about the meeting via the Member Orientation meeting flyers that are included in all new member packets. In comparison, during the same time period in 2014, only 9 members attended a Member Orientation meeting. Non-Emergency Medical Transportation (NEMT) GCHP implemented the revised NEMT process on March 1, 2015, which was discussed with Committee members at the December 2014 meeting. The revised process shifts the 6-1

12 approval process from Ventura Transit Systems (VTS) to the provider and requires the Member s provider to submit a NEMT Prescription Form to GCHP, attesting that the Member meets the requirements for NEMT. Once GCHP receives the completed form, it will be reviewed for completeness and forwarded to VTS. VTS will then contact the member to arrange the ride. Health Services reports that they are receiving several requests daily and the new process is working well. The biggest issue encountered involves incomplete forms. Health Services is contacting the requesting provider to obtain the missing information. GCHP is also keeping a list of suggested improvements to the form for the next revision. 6-2

13 ACA Expansion Program Update Consumer Advisory Committee March 18, 2015 Tami Lewis, Director of Operations 6-3

14 GCHP Membership Total Membership as of March 1, ,795 New Members Added Since January ,283 GCHP Membership Increase April March , , , , , , , , , , ,000 Active Membership Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Active Membership 141, , , , , , , , , , , ,795 Change from Prior Month 8,000 6,000 4,000 2,000 0 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar

15 Membership Growth GCHP New Membership Breakdown 4,965 L1 - Low Income Health Plan % M1 - Medi-Cal Expansion % 20,480 7U - CalFresh Adults % ,350 3,234 7W - CalFresh Children % 7S - Parents of 7Ws -.62% Traditional Medi-Cal % Note: GCHP Pended eligibility (not shown) 2,003 (increased 237 from February) Members with aid code 8E accelerated enrollment which provides immediate temporary, fee-for service, full scope Medi-Cal benefits for ages 65 and under 6-5

16 Government Relations Update Consumer Advisory Committee March 18, 2015 Guillermo Gonzalez, MPP Director of Government Relations 7-1

17 Medi-Cal Program Overview CA s Medi-Cal is the largest in the U.S. (2x more than NY) Approx. 12M or 1/3 of state enrolled 3M enrolled since January 2013 Approx. 100K people transferred from Covered CA to Medi-Cal since 1/

18 New DHCS Leadership Jennifer Kent is the new Director Mari Cantwell is the Chief Deputy Director of Health Care Programs Hannah Katch is the Assistant Deputy Director of Health Care Delivery Systems Claudia Crist is the Deputy Director of Health Care Delivery Systems 7-3

19 CCI & Cal MediConnect Two new counties implementing Cal MediConnect-Santa Clara and Orange Governor s Budget-threat of elimination due to low enrollment DHCS is asking for ideas from Plans on how to educate consumers and providers that are encouraging opt-outs Consumer Bill of Rights 7-4

20 CCS Redesign Stakeholder process has begun CAHP and several plans are on the Redesign Stakeholder Advisory Board Plan engagement/input Not part of the current 1115 Waiver timeline-doesn t have to be completed by March 7-5

21 Palliative Care DHCS starting stakeholder process No proposal at this point CAHP established a workgroup Collecting information on best practices CAHP to provide recommendations to DHCS 7-6

22 Health Homes DHCS is moving forward with the new health homes option as created under the ACA and a part of the 1115 waiver renewal DHCS can only implement if there are no additional costs to the General Fund The funding and payments to plans under this model has not been established Targeted populations- frequent utilizers and those experiencing homelessness Implementation is scheduled for 1/1/2016 DHCS will be reaching out to assess where there is intent in this program by individual plans 7-7

23 FQHC Payment Reform-SB 147 DHCS was not willing to move forward on any FQHC payment reform unless clinics take some risk clinics agreed in concept to take on risks FQHC Payment Reform is not part of the 1115 waiver DHCS wants to move away from volume to value based payment California Primary Care Association (CPCA) very focused on this issue 7-8

24 LEGISLATIVE UPDATE Democrats hold majority in both chambers but not 2/3 Supermajority Now need Republican votes to pass tax bills 7-9

25 Leadership Assembly Speaker: Toni Atkins (D-San Diego) President Pro Tempore of Senate: Kevin de Leon (D- Los Angeles) Assembly Republican Leader: Kristin Olsen (R- Modesto) Committee assignment power 7-10

26 Committee Chairs Assembly Health Rob Bonta Assembly Budget Sub 1 Tony Thurmond Senate Health- Ed Hernandez Senate Budget Sub 3 Holly Mitchell 7-11

27 Legislative Calendar First Year of Two-Year Session Bill Introduction Deadline Feb. 27 Budget Must be Passed by June 15 Session Ends on Sep

28 Legislative Themes MCO Tax Drugs (Pricing/Specialty Tiers etc ) Cost Containment and Transparency Access/ Network Adequacy State Budget Issues MCO Tax Annual Open Enrollment Periods 7-13

29 Priority Legislation Medi-Cal Bills AB 187/SB 586 (Bonta & Hernandez) MCMC: CCS SB 33 (Hernandez) Medi-Cal Estate Recovery SB 147 (Hernandez) FQHC Payment Reform Medi-Cal Rates AB 366 (Bonta) Medi-Cal Rates Increase SB 243 (Hernandez) Medi-Cal Rates Increase Provider Directories SB 137 (Hernandez) Directory Requirements/Template 7-14

30 Questions? 7-15

31 Behavioral Health Utilizer Demographics Consumer Advisory Committee March 18, 2015 Nancy Wharfield, MD Associate Chief Medical Officer 8-1

32 1 Behavioral Health Utilizer Demographics October December 2014 Language Language Member Count Arabic 1 American Sign Language 1 English % 0.12% 0.12% 0.37% 14.73% 0.12% Farsi % No Response 3 Other - Non-English 2 Spanish 119 Grand Total 808 Arabic American Sign Language English Farsi No Response Other - Non-English Spanish 8-2

33 2 Age Band Member Count 0 to to Grand Total % Age Band 1% 31% 0 to to

34 3 Ethnicity Member Count Alaskan Native or American Indian 4 Amerasian 2 Asian or Pacific Islander 34 Black 19 Cambodian 1 Filipino 2 Hawaiian 1 Hispanic 292 Japanese 2 Korean 1 No reponse/declined to state 36 Other 39 White 375 Grand Total % 4.83% 0.50% Ethnicity 0.25% 2.35% 0.12% 0.25% 4.21% 0.12% 36.14% 0.25% 0.12% 4.46% Alaskan Native or American Indian Amerasian Asian or Pacific Islander Black Cambodian Filipino Hawaiian Hispanic Japanese Korean No reponse/declined to state Other White 8-4

35 4 Aid Category Member Count Adult Expansion 260 Aged 8 BCCTP 2 Disabled 94 Family 251 Family/Adult 116 TLIC 77 Grand Total % 31.06% Aid Category 9.53% 32.18% 11.63% 0.99% 0.25% Adult Expansion Aged BCCTP Disabled Family Family/Adult TLIC 8-5

36 winning health Issue 1 Winter 2015 STAY COVERED Don t forget to renew your Medi-Cal If you are a Medi-Cal Member, you will need to renew your eligibility once a year. Also called a redetermination, renewals are done by the Ventura County Human Services Agency (HSA), not Gold Coast Health Plan (GCHP). Medi-Cal stopped doing renewals between January and May of If your renewal month was during that time, you should have gotten a notice letting you know your new renewal month. How will I know when I need to renew? You will get a notice and the renewal forms in the mail two months before your renewal date. If you have moved since you signed up, call your local Medi-Cal office with your new address. How do I renew? Your renewal notice tells you what information you need to provide. If you do not renew before the due date, your Medi-Cal benefits will be suspended. You can renew by mail, by phone, in person or online. If you are missing information, call, send or bring in what you have. Call the number on the form if you have questions or call If you don t complete your renewal, your Medi-Cal benefits will be suspended. You will have 90 days to complete the renewal to reopen your Medi-Cal. If you reopen between 60 and 90 days after your Medi-Cal ended, you will have State Medi-Cal for a month or two before becoming a GCHP Member again. After 90 days, your Medi-Cal benefits will end, and you will have to reapply. What does it mean if I lose my Medi-Cal? If you lose your Medi-Cal, you will lose your health care coverage and will no longer be a GCHP Member. You can reapply, but you may have a break in your coverage. If you have Medi-Cal through Social Security. If you have Medi- Cal because you are receiving Supplemental Security Income (SSI), the Social Security office will let you know when you need to renew your eligibility. TAKE ACTION. For help renewing your Medi-Cal, call Ventura County Human Services Agency at Standard U.S. Postage PAID Long Beach, CA Permit No